Objectives Evaluate the impact of age, stage and histology on survival in high-risk endometrial cancer (EC) following treatment with chemotherapy and radiation (CTRT) vs. radiation alone (RT).
Methods Eligible patients were diagnosed with high-risk EC from 2004–2014 in the National Cancer Database based on PORTEC-3 criteria and treated with pelvic beam radiation and/or radioactive implants. The CTRT group also received multiple-agent chemotherapy. A propensity score approach controlled for differences in clinical factors. Survival was evaluated using weighted Kaplan-Meier and Cox model analyses with interaction testing.
Results There were 10,009 women in the CTRT group and 10,006 in the RT group. After balancing, a 4.9% improvement in 5-year survival and a 15% drop in the adjusted risk of death was observed following treatment with CTRT vs. RT (P<0.0001). The survival benefit and reduction in the risk of death associated with CTRT vs. RT alone varied by age at diagnosis, stage and/or histology (figure 1, P<0.0001 for each interaction test) with the largest benefits at age ≥70 vs. <70 years old, with stage III vs. stage I/II disease and in serous/clear cell carcinoma vs. endometrioid carcinoma. CTRT was associated with a 20% increased risk of death in patients <70 years old with stage I/II endometrioid EC (P<0.0001).
Conclusions Age, stage and histology merit consideration when selecting adjuvant therapy for high-risk EC patients based on a study in 20,015 women.
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